Thanks to Bob Sears, M.D. who provided the information contained in this article in an open letter to parents in the state of California. Dr. Sears is a California pediatrician who offered expert testimony in opposition to SB 277 before legislative committees during deliberations of the bill.

The new forced vaccination law for California school-aged children, SB277, passed both houses of the legislature and was signed into law by Governor Brown on June 30, 2015. The new law eliminates the ability of parents to exempt their child from vaccination for personal/philosophic and religious reasons. The law goes into effect for the 2016/2017 school year.

The sole remaining exemption from compliance with the CDC-recommended vaccine schedule in California that is available to parents is a medical exemption. The following excerpt from SB277 defines medical exemption:

“If the parent or guardian files with the governing authority a written statement by a licensed physician to the effect that the physical condition of the child is such, or medical circumstances relating to the child are such, that immunization is not considered safe, indicating the specific nature and probable duration of the medical condition or circumstances, including, but not limited to, family medical history, for which the physician does not recommend immunization, that child shall be exempt…to the extent indicated by the physician’s statement.”

Parents who prefer to skip vaccines in whole or in part still have a few other options to consider: A “grandfather” clause in the bill allows unvaccinated children to remain in school until they reach a “checkpoint” year. Checkpoint years are as follows: when a child first enrolls in a new school (no matter what age), when a child reaches kindergarten, and when a child reaches 7th grade. Upon enrollment in the 7th grade, a child will be required to either catch up on all missing vaccines, or begin catching up on missing vaccines using a “conditional” entry to school, described below.

A teen enrolled in 7th grade or above is also grandfathered, unless he or she changes school districts.

Unvaccinated preschoolers enrolled with a current Personal Belief Exemption (PBE) continue their exemption until enrollment in kindergarten.

Children enrolled in a transitional kindergarten who have a PBE and remain in the same school are also grandfathered. Note: PBE forms must be submitted before the end of 2015.

For children not grandfathered and not exempted for medical reasons, California will still allow a “conditional” entry into school. This means a child not in compliance with current vaccine requirements can still be enrolled, if a plan to eventually complete vaccination is in place. In such cases a written letter from the child’s doctor is required that outlines the plan. Schools have some flexibility on this point, and children may be able to spread the required vaccines out over a few years.

A concession made by the lawmakers in California is that children who qualify for an Individualized Education Plan (IEP) utilizing special education services will not be subject to the mandatory vaccination law. This means that most children with special needs will be allowed to attend school regardless of vaccine status.

Children who are homeschooled are exempt from vaccination requirements according to the new law. Homeschool during preschool and kindergarten is a viable option, since full vaccination is not a requirement for children being homeschooled. Home-based education was already becoming more popular before mandatory vaccination laws were introduced. Some families embrace this lifestyle, and many children and families thrive outside of standard educational systems. This new law will likely prompt more families to make this choice.

Homeschooling doesn't necessarily mean kids need to be isolated and educated one-on-one with one of the parents as a full-time teacher. Co-op programs, in which families group their children together for educational, social, athletic, and cultural experiences will become more popular. Parents won't be the only ones responsible for teaching; they can share duties with other parents, tutors, even private teachers, and such costs can be shared among many families. Parents should be able to work part-time outside the home if desired or needed.

For parents seeking a medical exemption, here are some of the circumstances that may prompt a doctor to authorize one for a child or family:

-A child previously suffered a severe vaccine reaction.

-Siblings of a child previously suffered a severe vaccine reaction.

-A parent previously suffered a severe vaccine reaction.

-Other, more distant relatives previously suffered a severe vaccine reaction. Prior adverse vaccine reactions that occurred in grandparents, aunts and uncles, or cousins are less concerning in this regard, as the genetic risks are not as closely shared. However, parents can and should discuss such medical histories with their physician.

-A child with a current severe medical condition or chronic health condition. Parents whose child suffers a chronic illness or a temporary, moderate-to-severe condition should discuss with their doctor whether or not that condition warrants temporary or permanent exemption.

-A family history of severe medical conditions. There is a growing body of research linking vaccination and an increased risk of autoimmune disease. Families with lupus, rheumatoid arthritis, celiac disease, fibromyalgia, multiple sclerosis, type I diabetes, and other autoimmune conditions can and should discuss exemptions.

Families with neurodevelopmental or psychiatric conditions can also discuss this with their doctor. The greater the number of familial diseases, and the closer in the family they occur to the child in question, the more likely is the need to consider exemption.

-Autism in the family. Many families will consider seeking exemptions for a child with autism and the rest of their children. Autism in more distant relatives would be less of a concern for a baby but can be considered.

-Other learning and behavioral disorders in the family. Disorders that are less severe than autism, such as ADHD, ODD, and others, are less of a concern but warrant consideration by families and their doctors.

-Allergies in the family. This is perhaps one of the most common disorders for which families may try to get a medical exemption. If a family’s challenges are significant, such as multiple close family members with asthma, eczema, and life-threatening food allergies, consideration for exemption could be valid.

-Genetic abnormalities in a family. There is a growing trend to perform genetic testing on families to evaluate current medical problems and to predict future health risks. Some have theorized that genetic defects that impair detoxification and antioxidant function in the body may increase the risk of severe vaccine reactions. It is important to know that no research has yet been done to determine if this is true. One particular gene variation which exists in most families with autism is called the MTHFR gene, and many such families believe this gene defect warrants medical exemption from vaccines. Until research supports this theory, this couldn't be used as a definite reason for exemption. Doctors certainly have the right to consider anything they want to, but I can't find any medical justification for this yet.

Many parents choosing to not vaccine their children may wish to hold off on pursuing a medical exemption altogether at this time, since it may be years before one is actually needed. In fact, many students will not need one. The grandfathering clause and having an IEP both allow for vaccination exemption.

In California, no specific exemption form exists at this time; the exemption is simply a letter from the doctor. Parents will submit it to the school, and the school administrator will determine whether or not the letter meets the legal guidelines of the state. Since very few school administrators have the medical expertise to understand or contradict a medical doctor's opinion on this, it is likely that most such letters will be accepted. If the letter is not accepted, parents may attempt to enroll the child into another school where the school staff is more understanding. For example, standard public schools will likely be stricter than charter public schools or small private schools.

The bottom line is that it is imperative that all families and doctors operate within the guidelines of the law and the standard of medical care. There is no certain medical standard of care on this issue. That will evolve over time.

What options are there for parents who do not want to vaccinate, but cannot get a medical exemption, cannot home school, and cannot move out of California? Unfortunately, for some families the only choices are to move out of state or else try to work the system within the confines of the law. A conditional entry vaccine plan may be the best way to keep a child in school; parents can work with the doctor and the school to find the best plan to gradually introduce vaccines slowly, one-at-a-time, spread out over many years. Parents may explore the schools in the area to learn which are more friendly toward families who submit medical exemptions, as these schools are likely to also be more lenient with conditional entry plans (such as public charter schools or small private or religious schools).

WHAT SHOULD YOU DO RIGHT NOW?

If your child is grandfathered in, don't do anything at this time other than stay in the same school if possible. Be sure to get in a PBE form before 2015 ends. When the grandfathering time runs out (your child reaches kindergarten, 7th grade, or you have to change schools), make an appointment with a doctor to discuss other options.

Get your child into a school this year so you can be grandfathered in for at least a few years.

If your child has an IEP, don't do anything. Stay in school. Never let that IEP go. Your child can remain unvaccinated.

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